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Vaginal trauma causing haemorrhage - caesarean or VB next time?

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#1 Imalittleteapot

Posted 03 February 2017 - 04:56 PM

I had a very traumatic birth the first time - long and difficult labour, then while I was pushing, baby's heart rate was not responding well so Ob decided on forceps to get him out. This resulted in internal vaginal tearing (only 2nd degree tears externally) which ripped through blood vessels and I lost 3L of blood very quickly. Said bye to hubby and baby and was whipped off to theatre which was a pretty awful experience in itself. I had to spend days in ICU, did not bond with DS for a long time, developed PND, could not produce breastmilk, had really bad haemarrhoids and a lot of physio to deal with the scar tissue but all in all despite the psychological trauma I recovered fairly quickly physically compared with others who had say 3rd of 4th degree tears and have long-lasting issues.

I am due in a few months with DS2 and was certain that I had to have a caesarean as I could not deal with a repeat of last time. But the last few days after reading more about caesareans and all the possible issues I have started considering the idea of a vaginal birth again. The OB last time said my next birth could go either way - in general subsequent births are easier with less tearing but he has also seen it happen again to people second time round.

I'm finding it really difficult to make this decision. I would love to have a vaginal birth that goes well and gives me the best chance to bond and breastfeed, but I will be going in with a fair bit of anxiety and there is the risk of another haermorrhage. A caesarean appeals because obviously my vagina is not going to be ripped apart, and i like the idea that it will be planned and controlled with less chance of surprises, but on the other hand i have read about the long recovery, possible long-term complications (I also have that keloid scarring issue) and just in general a bit fearful of the idea of major surgery.

Would love to hear others thoughts. If you had another VB after a traumatic birth how did you manage the anxiety and fear going into it? I am not talking about hypno/calm birthing type stuff since I am not worried about the labour part of it, just how did you manage the fear of things going wrong again? Last time I just convinced myself that nothing bad would happen (and then it did) so I dont think that strategy will work for me again.

Or if you had a caesarean the second time, did you find it was a much better experience?

#2 FretfulMum

Posted 03 February 2017 - 05:09 PM

I'm sorry you had such a traumatic birth, that really sounds very awful and I would be frightened of it happening again too.

My first birth was traumatic but in a different way. I had an emergency CS at 30wks after developing severe pre-eclampsia. DS spent 10wks in hospital and I was very unwell also. I'm due soon with DS2 and am planning on an elective CS. I'm really just looking forward to a birth that isn't as chaotic and unplanned/dramatic as first time.

I just wanted to let you know that I recovered very quickly from the CS- was driving within 2 wks and had very minimal pain. I also bonded very well with DS even though I couldn't hold him for several days and he was in hospital for so long. I also had very good milk supply and breastfed DS. So these things are possbible when you have a CS. I hope this might help you with your decision

#3 Mummy_Em

Posted 03 February 2017 - 07:40 PM

I had a fourth degree tear and 2 litre haemorrage with my first and opted for a c/s second time around. My doctors were happy to support me going either way, and there is a good chance the next birth would have been incident free, but my main worry was that if something went wrong I might be adding further damage to my pelvic floor and possibly risking permanent incontinence.

My planned c/s was great, a bit nerve wracking going into theater and I was pretty uncomfortable for the first 24-36 hours. You have to go into recovery until they are happy that the spinal is wearing off normally, and they are happy with your bleeding, and then you go back to your room still with the catheter in. That can come out once the spinal has worn off enough for you to get up and go to the toilet. You probably would have experienced all this when you had your repairs last time. I think that is the worst time with a c/s, but it was honestly still better than post tear repair for me. The stitches came out after 5 days, which the visiting midwife did for me at home.

I can't help you with the keloid scarring. But with the bonding, as your hospital about their policies around keeping baby and mum together after a c/s. My second daughter was placed on my chest in theatre and and immediately rooted around and found the breast and fed while I was stitched. It was the best experience after having had to hand my first daughter to her dad within a few minutes of the birth to go off to theatre. I had my third daughter in a older hospital with outdated practices and was discouraged from even having her with me in recovery.

#4 niban

Posted 03 February 2017 - 07:58 PM

With my first I was similar to you, long difficult labour, forceps, 2l PPH and long recovery. I really wanted a VB with the second and went thru a birth centre (which was great). As it was I ended up with a c-section (looked like i wasn't progressing, then as I had an epidural and moved to labour ward I had several huge contractions and ended up dilating fully - unfortunately with the epidural it then all stalled and I had the c-sect hours later)  I ended up leaving hospital after 40 hrs and recovered really well - made me realise just how bad the first was, esp the affects of the blood loss.  No regrets about giving the VB a try but had I known how it was going to pan out and how much better the recovery was with no trauma downstairs I think I would have just gone for the c-section.

#5 ~LemonMyrtle~

Posted 03 February 2017 - 08:22 PM

My first was pretty traumatic, long induction, long pushing, eventual forceps with episiotomy. Recovery was long and hard and I had huge issues BF due to undiagnosed extreme tongue tie and constant vaginal and bottom pain for weeks plus incontenanance that took ages to get better.

And then I got pregnant again 5 months PP!!!

I guess there was a lot of tears and fears at times about the second birth. But I did change things a bit. I moved to a new hospital because I wasn't happy with the care I got at the first. I planned on a very early epidural, so should the worst happen then at least I would be calm and without pain. I saw a great women's physio. And I prayed that the 'second births are easier' would be true. And I figured I'd been through the worst anyway.

In the end my second birth was wonderful! Everything went to plan. I went into labour on a Sunday afternoon when hubby was home, gave birth vaginally just after midnight without pain due to my early epidural. And I only had a small tear with one or two stitches despite him coming out sunny side up. And he BF like a champion.

Granted, DS2 was much smaller than my first born, but still it all went really well. And it was healing mentally to have a successful vaginal birth after I felt like a bit of a failure after the first, I kind of feel now like "I can do it!"

On the other hand after a failed natural labour and an emergency c-sect my friend had a planned c-sect for her second and found that to be calm and planned and relaxed and so much bette then her first birth. And her second BF better too.

Good luck with your second whatever you decide to do.

#6 Makalu

Posted 03 February 2017 - 08:28 PM

I wrote an almost identical post to you about a year ago. My first bub was induced at 42 weeks, posterior, long labour and long pushing stage. His heart rate kept dropping so they tried vacuum x 2 which failed then he was a forceps deliver resulting in a massive tear through to my anal canal and a 1.5L haemorrhage. I went straight to the operating theatre with no chance to hold my baby for hours. I had a horrible time in the weeks-months after he was born both physically and mentally.

I just had my baby girl a couple of months ago and I agonised over what to do for most of the pregnancy. I ended up choosing an elective cesarean and it was the best experience I could have hoped for. I had skin to skin within minutes of her being born and she was breastfeeding like a champion in the recovery room. Other than a bit of pain for the first week or so that was controlled with medication the recovery has been fantastic compared to last time. I now (at 2 months) feel completely normal both physically and mentally and loved my both experience as feel like it was so controlled and happened exactly to plan.

All that said if I had gone for another vaginal birth it's likely that would have been a good experience too. I just decided I couldn't accept the risk of being one of the unfortunate few who had the same thing happen on two occasions.

Good luck with whatever you decide and congratulations on your pregnancy.

Edited by Makalu, 03 February 2017 - 08:30 PM.

#7 Treasure Island

Posted 03 February 2017 - 09:40 PM

My first was an emergency ceaser due to distress (meconium in waters, didn't labour). I decided to VBAC number 2 but he became stressed during labour and I was induced and then had an assisted (vacuum) delivery. This gave me my tears and PPH. I had to go to theater to have a spinal for stitching as the local didn't work. Not sure how much blood I lost but I was very white afterwards and barely missed having a transfusion. I had to have iron tablets for a few months. I also had a lot of trouble sitting and using the toilet for 2 weeks after. For number 3 the OB was happy for me to try VBAC again but I said no and opted for an elective ceaser instead. Had it only been my second I might have tried again to go vaginal.

#8 Contrebasse

Posted 03 February 2017 - 11:07 PM

I had a 3rd degree tear first time round and an elective CS the second time.

The CS was fantastic, a calmer birth and much better recovery. No real pain, and onto panadol only after a couple of days. A walk in the park compared to labour! The only downside is my scar is a bit bumpy and still occasionally itchy (after nearly 2 years). Most importantly I didn't destroy my pelvic floor (well, any further than I had already!)

#9 chicken_bits

Posted 04 February 2017 - 10:58 AM

Have you spoken to the midwives/OB about this?

My experience was far less traumatic than yours but I still think it's worth sharing.

I had a long labour with DD and a straightforward delivery until on her way out she wiggled her head and tore me to shreds. If memory serves me correctly it was a 3rd degree tear and it took about an hour to repair because it was all jaggered. I also had a 1.5L PPH.

With DS, I wasn't allowed to go through the birth centre because they were concerned about the PPH I had. Instead, they had a plan to have meds on hand to manage the potential risks of a bleed. Is that something you can discuss with them? DS's birth was perfect. I had a smaller bleed (600ml) and no tearing. I know I am very lucky.

#10 Soontobegran

Posted 04 February 2017 - 02:29 PM

Your experience sounds awful and I understand your dilemma.

If I was in your position I would most definitely choose a lovely peaceful well planned elective C/S.
I know for a fact I would be concerned about a repeat situation even though most likely it would never happen......I believe I would be too anxious which would take the excitement away from the celebrations of the new baby coming.

Only you know what is right for you though....good luck making your choice.

#11 Imalittleteapot

Posted 04 February 2017 - 10:35 PM

Thanks everyone for sharing your experiences and i'm happy to hear most people had much better subsequent births. Its given me something to think about and honestly I am now leaning pretty strongly towards the caesarean. Just knowing that gives me a big feeling of relief so I think it is probably the right decision for me.

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